Towards a Globalised Vision of Aquatic Competence

Human interaction with the aquatic environment has always taken different forms to meet the needs of pleasure, survival, therapy or performance. The diversity of existing aquatic spaces presents itself as a challenge, due to their variety, dynamism, unpredictability and unrepeatable conditions. These factors potentiate an infinite number of possibilities for human response in interaction with the aquatic environment, with aquatic competence being the one that will be able to sustain all types of interaction. Thus, the aim of the proposal has been to present a new approach to the contextualisation of aquatic competence. After a literature review on the concept of aquatic competence, a three dimensional model is presented: aquatic literacy, drowning prevention and environmental education. Recognising the human being as a bio-psycho-social being, a holistic model is developed, where the dimensions are based on three types of know-how (to be, to know and to do). In turn, these knowledges are influenced by the socio-cultural environment, the aquatic environment, the self and by others. Considering its breadth and the focus on the human being, this ecological model should not be a privilege, but a condition of aquatic programmes. Therefore, the acquisition of aquatic competence is presented as a civic necessity

KRAS Early Testing: Consensus Iniziative and Cost-Effectiveness Evaluation for metastatic colerectal patiens in an Italian Setting

Abstract KRAS testing is relevant for the choice of the most appropriate first-line therapy of metastatic colorectal cancer (CRC). Strategies for preventing unequal access to the test should be implemented, but their relevance in the practice is related to economic sustainability. The study adopted the Delphi technique to reach a consensus on several topics. Issues related to execution of KRAS testing were identified by an expert\u2019s board and proposed to 108 Italian oncologists and pathologists through two subsequent questionnaires. The emerging proposal was evaluated by decision analyses models employed by technology assessment agencies in order to assess cost-effectiveness. Alternative therapeutic strategies included most commonly used chemotherapy regimens alone or in combination with cetuximab or bevacizumab. The survey indicated that time interval for obtaining KRAS test should not exceed 15 days, 10 days being an optimal interval. To assure the access to proper treatment, a useful strategy should be to anticipate the test after radical resection in patients at high risk of relapse. Early KRAS testing in high risk CRC patients generates incremental cost-effectiveness ratios between 6,000 and 13,000 Euro per quality adjusted life year (QALY) gained. In extensive sensitivity analyses ICER\u2019s were always below 15,000 Euro per QALY gained, far within the threshold of 60,000 Euro/QALY gained accepted by regulatory institutions in Italy. In metastatic CRC a time interval higher than 15 days for result of KRAS testing limits access to therapeutic choices. Anticipating KRAS testing before the onset of metastatic disease in patients at high risk does not affect the sustainability and cost-effectiveness profile of cetuximab in first-line mCRC. Early KRAS testing may prevent this inequality in high-risk patients, whether they develop metastases, and is a cost-effective strategy. Based on these results, present joined recommendations of Italian societies of Oncology and Pathology should be updated including early KRAS testing

Avaliação antropométrica longitudinal de lactentes nascidos de mães infectadas pelo HIV-1

OBJETIVO: Evaluar los parámetros de crecimiento en lactantes nacidos de madres infectadas con el VIH-1. MÉTODOS: Evaluación longitudinal de los z-escores peso-edad (PI), estatura-edad (EI), peso-estatura (PE) fue realizada en una cohorte. Fueran estudiados 97 lactantes no infectados y 33 lactantes infectados nacidos de madres infectadas con el VIH-1 en Belo Horizonte, Sureste de Brasil, de 1995 a 2003. El tiempo medio de seguimiento para los lactantes infectados y no infectados fue de 15,8 meses (variación: 6,8 a 18,0 meses) y 14,3 meses (variación: 6,3 a 18,6 meses), respectivamente. Se utilizó el modelo de regresión linear de efectos mixtos ajustado por máxima verosimilitud restringida para construir las curvas de crecimiento. RESULTADOS: Los z-escores PI, EI y PE de los lactantes infectados con el VIH-1 presentaron decrecimiento. A los seis meses, la diferencia promedio en los z-escores PI, EI y PE entre lactantes infectados y no infectados con el VIH era, respectivamente, 1,02, 0,59 y 0,63 desviaciones-estándares. A los 12 meses, la diferencia promedio en los z-escores PI, EI y PE entre lactantes infectados y no infectados era, respectivamente, 1,15, 1,01 y 0,87 desviaciones-estándares. CONCLUSIONES: El comprometimiento precoz y creciente de los indicadores antropométricos de niños infectados con el VIH-1 muestra la importancia de identificar precozmente niños infectados con el VIH que están en riesgo nutricional y la necesidad de evaluarse continuamente las intervenciones nutricionales adoptadas.OBJECTIVE: To evaluate the growth parameters in infants who were born to HIV-1-infected mothers. METHODS: The study was a longitudinal evaluation of the z-scores for the weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) data collected from a cohort. A total of 97 non-infected and 33 HIV-infected infants born to HIV-1-infected mothers in Belo Horizonte, Southeastern Brazil, between 1995 and 2003 was studied. The average follow-up period for the infected and non-infected children was 15.8 months (variation: 6.8 to 18.0 months) and 14.3 months (variation: 6.3 to 18.6 months), respectively. A mixed-effects linear regression model was used and was fitted using a restricted maximum likelihood. RESULTS: There was an observed decrease over time in the WAZ, LAZ and WLZ among the infected infants. At six months of age, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.02, 0.59, and 0.63 standard deviations, respectively. At 12 months, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.15, 1.01, and 0.87 standard deviations, respectively. CONCLUSIONS: The precocious and increasing deterioration of the HIV-infected infants' anthropometric indicators demonstrates the importance of the early identification of HIV-infected infants who are at nutritional risk and the importance of the continuous assessment of nutritional interventions for these infants.OBJETIVO: Avaliar os parâmetros de crescimento em lactentes nascidos de mães infectadas com o HIV-1. MÉTODOS: Avaliação longitudinal dos z-escores peso-idade (PI), estatura-idade (EI), peso-estatura (PE) foi realizada em uma coorte. Foram estudados 97 lactentes não-infectados e 33 lactentes infectados nascidos de mães infectadas com o HIV-1 em Belo Horizonte, MG, de 1995 a 2003. O tempo mediano de seguimento para os lactentes infectados e não-infectados foi de 15,8 meses (variação: 6,8 a 18,0 meses) e 14,3 meses (variação: 6,3 a 18,6 meses), respectivamente. Utilizou-se o modelo de regressão linear de efeitos mistos ajustado por máxima verossimilhança restrita para construir as curvas de crescimento. RESULTADOS: Os z-escores PI, EI e PE dos lactentes infectados com o HIV-1 apresentaram decréscimo. Aos seis meses, a diferença média nos z-escores PI, EI e PE entre lactentes infectados e não-infectados com o HIV era, respectivamente, 1,02, 0,59 e 0,63 desvios-padrão. Aos 12 meses, a diferença média nos z-escores PI, EI e PE entre lactentes infectados e não-infectados era, respectivamente, 1,15, 1,01 e 0,87 desvios-padrão. CONCLUSÕES: O comprometimento precoce e crescente dos indicadores antropométricos de crianças infectadas com o HIV-1 mostra a importância de identificar precocemente crianças infectadas com o HIV que estão em risco nutricional e a necessidade de se avaliarem continuamente as intervenções nutricionais adotadas

CD40 ligand and MCP-1 as predictors of cardiovascular events in diabetic patients with stroke

Aim: Up-regulation of soluble CD40 ligand (sCD40L) and of monocyte chemoattractant protein-1 (MCP-1) has been found in diabetes and in patients with acute cerebral ischemia. We asked whether (i) the two molecules are similarly upregulated among non-lacunar and lacunar diabetic strokes and (ii) sCD40L and/or MCP-1 predict the risk of cardiovascular events in this setting.Methods: Ninety patients with type 2 diabetes mellitus presenting with an acute ischemic stroke (compared with 45 control subjects) were evaluated on admission and up to 36 months (median 24 months) after the event.Results: Diabetic patients with acute stroke had higher plasma CD40L and MCP-1 than controls (p<0.0001), with no significant differences among lacunar and non-lacunar strokes. On multiple regres-sion analysis, only higher sCD40L quartiles and older age were associated with higher MCP-1 quar-tiles. Forty-eight percent of patients experienced vascular events. Cox regression analysis showed that only the presence of higher sCD40L values independently predicted the recurrence of vascular events.Conclusion: Up-regulation of inflammatory molecules, such as CD40L and MCP-1, is involved in the advanced stage of atherosclerotic cerebro-vascular disease and is associated with increased risk of recurrence of cardiovascular events.AIM: Up-regulation of soluble CD40 ligand (sCD40L) and of monocyte chemoattractant protein-1 (MCP-1) has been found in diabetes and in patients with acute cerebral ischemia. We asked whether (i) the two molecules are similarly upregulated among non-lacunar and lacunar diabetic strokes and (ii) sCD40L and/or MCP-1 predict the risk of cardiovascular events in this setting. METHODS: Ninety patients with type 2 diabetes mellitus presenting with an acute ischemic stroke (compared with 45 control subjects) were evaluated on admission and up to 36 months (median 24 months) after the event. RESULTS: Diabetic patients with acute stroke had higher plasma CD40L and MCP-1 than controls (p<0.0001), with no significant differences among lacunar and non-lacunar strokes. On multiple regression analysis, only higher sCD40L quartiles and older age were associated with higher MCP-1 quartiles. Forty-eight percent of patients experienced vascular events. Cox regression analysis showed that only the presence of higher sCD40L values independently predicted the recurrence of vascular events. CONCLUSION: Up-regulation of inflammatory molecules, such as CD40L and MCP-1, is involved in the advanced stage of atherosclerotic cerebro-vascular disease and is associated with increased risk of recurrence of cardiovascular events

A re-entry tachycardia triggered by the spontaneous interruption of an atrial tachycardia.

The common atrioventricular nodal re-entry tachycardia is the most common form of paroxysmal supraventricular tachycardia. It starts frequently with a supraventricular ectopic beat that, on finding the fast pathway in refractory period, travels in the slow pathway as to appear as a prolongation of the PR interval on the ECG. In this study, we show a singular case of a common atrioventricular nodal re-entry tachycardia triggered by the spontaneous interruption of an atrial tachycardi

3-(2,4-Dibromo­anilino)-2,2-dimethyl-2,3-dihydro­naphtho[1,2-b]furan-4,5-dione: a new substituted aryl­amino nor-β-lapachone derivative

The title compound, C20H15Br2NO3, shows the furan ring to adopt a half-chair conformation and the two ring systems to be approximately perpendicular [dihedral angle = 71.0 (2)°]. In the crystal structure, inter­molecular C—H⋯O contacts link the mol­ecules

Influence of the Shading on Growth Seedlings of Louro Pirarucu (Licaria canella (Meissn.) Kosterm.)

This paper evaluates the shading effect on seedlings of "Louro Pirarucu" (Licaria canella(Meissn) Kosterm. - Lauraceae). The trial was set up in the nursery at Adolph Ducke forest reserve. The seeds were germinated in wooden boxes with washed sand as a substrate. After seed germination, the seedlings were transplanted to black polyethylene bags. Four levels of shading (0%, 30%, 50% and 70%) is analyzed. Shading treatments were obtained with plastic shade clothes of different meshes. The experimental design was the randomized blocks with split-plot. Shading levels were considered plots and period of harvesting as sub-plots. Evaluations of potted seedlings were done after 30, 60 and 90 days for the following parameters: height, leaf area, leaf area ratio, aerial dry weight and root dry weight. The results suggest that: a) potted seedlings grown under 50% of shade presented higher values of aerial weight and root weight than plants under full sunlight radiation; b) height, leaf area and leaf area ratio were not significantly influenced by shading treatments; c) higher values of height and root weight were observed after 90 days.Com o objetivo de avaliar o efeito dos níveis de sombreamento no desenvolvimento de mudas de Louro pirarucu (Licaria canella(Meissn.) Kosterm. - Lauraceae), conduziu-se um ensaio em viveiro na Reserva Florestal Adolfo Ducke. As sementes foram colocadas para germinar em caixas de madeira contendo areia lavada como substrato e posteriormente foi feito o transplante das mudas para sacos plásticos de cor preta. Utitizou-se quatro diferentes níveis de sombreamento. Os níveis de 30%, 50% e 70% de sombreamento foram obtidos por meio de telas de poliolefinas de cor preta e o nível de 0% a céu aberto. Foi empregado o delineamento em blocos ao acaso com parcelas subdivididas; os níveis de sombreamento constituíram as parcelas e os períodos de avaliação das mudas as subparcelas. Após 30,60 e 90 dias de permanência no viveiro, as mudas foram avaliadas quanto à altura, área foliar, razão de área foliar, peso de matéria seca da parte aérea e do sistema radicular. Baseando-se nos resultados obtidos, pode-se concluira) as mudas produzidas sob 50% de sombreamento apresentaram maiores valores de peso da parte aérea e do sistema radicular quando comparadas com 0% de sombreamento ; b) a altura, área foliar e razão de área foliar não foram influenciadas significativamente pelos níveis de sombreamento; c) as mudas com maior desenvolvimento em altura e maior peso do sistema radicular foram obtidas com 90 dias

Treatment of patients with aortic atherosclerotic disease with paclitaxel-associated lipid nanoparticles

OBJECTIVE: The toxicity of anti-cancer chemotherapeutic agents can be reduced by associating these compounds, such as the anti-proliferative agent paclitaxel, with a cholesterol-rich nanoemulsion (LDE) that mimics the lipid composition of low-density lipoprotein (LDL). When injected into circulation, the LDE concentrates the carried drugs in neoplastic tissues and atherosclerotic lesions. In rabbits, atherosclerotic lesion size was reduced by 65% following LDE-paclitaxel treatment. The current study aimed to test the effectiveness of LDE-paclitaxel on inpatients with aortic atherosclerosis. METHODS: This study tested a 175 mg/m2 body surface area dose of LDE-paclitaxel (intravenous administration, 3/3 weeks for 6 cycles) in patients with aortic atherosclerosis who were aged between 69 and 86 yrs. A control group of 9 untreated patients with aortic atherosclerosis (72-83 yrs) was also observed. RESULTS: The LDE-paclitaxel treatment elicited no important clinical or laboratory toxicities. Images were acquired via multiple detector computer tomography angiography (64-slice scanner) before treatment and at 1-2 months after treatment. The images showed that the mean plaque volume in the aortic artery wall was reduced in 4 of the 8 patients, while in 3 patients it remained unchanged and in one patient it increased. In the control group, images were acquired twice with an interval of 6-8 months. None of the patients in this group exhibited a reduction in plaque volume; in contrast, the plaque volume increased in three patients and remained stable in four patients. During the study period, one death unrelated to the treatment occurred in the LDE-paclitaxel group and one death occurred in the control group. CONCLUSION: Treatment with LDE-paclitaxel was tolerated by patients with cardiovascular disease and showed the potential to reduce atherosclerotic lesion size

Chemoselective oxidation of benzophenazines by m-CPBA: n-oxidation vs. oxidative cleavage

Chemoselectivity is observed when a pyran-benzo[a]phenazine and a furan-benzo[a]phenazine from beta-lapachone and nor-beta-lapachone, respectively, were submitted to oxidation by m-CPBA. The pyran phenazine furnished mainly macrolactones, while the furan one led exclusively to a phenazine N-8 oxide. To understand this difference in reactivity, we synthesized a new furan phenazine, with the reactive double bond site less hindered than that of the derivative from nor-beta-lapachone. This furan phenazine, upon oxidation with m-CPBA, furnished mainly the expected macrolactone. These experimental results, along with preliminary analysis based on mechanical molecular calculations of the ground state of the substrates, allowed us to suggest that the observed chemoselectivity has a steric oxidant approach control origin, related to the presence of the geminal methyl groups in the phenazine structure. Several of the synthesized compounds are, herein, reported for the first time